Volume 6, 2020
Special Issue: "HIP and KNEE Replacement" Guest Editors: C Batailler, S Lustig, J Caton
|Number of page(s)||7|
|Published online||24 June 2020|
Angular limit for coronal joint deformity correction using intramedullary guidance in total knee arthroplasty. A pilot study
Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
2 Department of Orthopedic Surgery, Middle East Institute of Health, Bsalim, Lebanon
3 Chirurgie Orthopédique et de la Colonne Vertébrale, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France
4 Center for Evidence-based Anatomy, Sports & Orthopedic Research, Jdeideh, Lebanon
* Corresponding author: firstname.lastname@example.org
Accepted: 2 June 2020
Introduction: Post-operative misalignment of the lower limb mechanical axis following total knee arthroplasty (TKA) is thought to be associated with clinical failure. In a balanced knee, a neutral global mechanical axis following the use of intra-medullary (IM) guidance does not necessarily imply a horizontal TKA joint line. Using femoral and tibial axes separately would be more accurate in evaluating TKA alignment. Thus, the aim of the study is to define a pre-operative mechanical tibial and/or femoral angle threshold value for post-operative optimal alignment correction using IM guides. Methods: This single-center prospective continuous pilot study included 50 patients treated with a TKA for primitive osteoarthritis. Femoral and tibial cuts were performed using intramedullary (IM) guide. Three angles were calculated and analyzed pre and post-operatively on standing antero-posterior views using long-leg radiographs: femorotibial angle (FTA), mechanical femoral angle (MFA), and mechanical tibial angle (MTA). Statistical analysis was performed for the whole sample and for the three following FTA subgroups; normo-axial, varus and valgus. Results: The pre-operative MTA is the only parameter for which a threshold value was observed; when pre-operative MTA exceeded the value of 94°, an optimal correction might not be obtained post-operatively. Discussion: Our results suggest that the bony correction obtained via IM guiding depends exclusively on the primary deformation of the tibia. In cases of a varus of more than 94°, the IM guide was found to yield sub-optimal corrections. Thus, other solutions need to be investigated.
Key words: Total knee arthroplasty / Coronal deformity / Knee varus / Knee valgus / Correlation
© The Authors, published by EDP Sciences, 2019
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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